Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis of the PeDI registry
Annery G. García‐Marcinkiewicz, Lisa Lee, Bishr Haydar, John E. Fiadjoe, Clyde Matava, Pete G. Kovatsis, James Peyton, Mary Lyn Stein, Raymond Park, Brad M. Taicher, T. Wesley Templeton, Benjamin Bruins, Paul A. Stricker, Elizabeth Laverriere, Justin L. Lockman, Brian Struyk, Christopher Ward, Akira Nishisaki, Ramesh Kodavatiganti, Rodrigo J. Daly Guris, Luis Sequera‐Ramos, Mark S. Teen, Ayodele Oke, Grace Hsu, Arul M. Lingappan, Chinyere Egbuta, Stephen G Flynn, Lina Sarmiento, Tally Goldfarb, Edgar Kiss, Patrick Olomu, Peter Szmuk, Sam Mireles, Andrea Murray, Simon D. Whyte, Ranu Jain, Maria Matuszczak, Agnes I. Hunyady, Adrian Bösenberg, See Wan Tham, Daniel K. Low, Chris Holmes, Stefan Sabato, Nicholas M. Dalesio, Robert S. Greenberg, Angela Lucero, Paul I. Reynolds, Ian Lewis, Charles Schrock, Sydney Nykiel‐Bailey, Elizabeth Starker, Judit Szolnoki, Melissa Brooks-Peterson, Somaletha Bhattacharya, Nicholas E. Burjek, Narasimhan Jagannathan, David R. Lardner, Scott C. Watkins, Christy J. Crockett, John W. Moore, Sara B. Robertson, Madhankumar Sathyamoorthy, Franklin Chiao, Jasmine Patel, Aarti Sharma, Piedad Echeverry Marín, Carolina Pérez‐Pradilla, Neeta Singh, Britta S. von Ungern‐Sternberg, David Sommerfield, Guelay Bilen-Rosas, Hilana Lewkowitz-Shpuntoff, Pilar Castro, N. Ricardo Riveros Perez, Jurgen C. de Graaff, Eduardo Vega, A. González, Paola Ostermann, Kasia Rubin, C. De Lord, Angela Lee, Eugenie S. Heitmiller, Songyos Valairucha, Priti G. Dalal, Thanh Tran, Ihab Ayad, Mohamed Rehman, Allison Fernandez, Lillian Zamora, Niroop Ravula, Sadiq Shaik
Abstract
BACKGROUND: Difficult facemask ventilation is perilous in children whose tracheas are difficult to intubate. We hypothesised that certain physical characteristics and anaesthetic factors are associated with difficult mask ventilation in paediatric patients who also had difficult tracheal intubation. METHODS: We queried a multicentre registry for children who experienced "difficult" or "impossible" facemask ventilation. Patient and case factors known before mask ventilation attempt were included for consideration in this regularised multivariable regression analysis. Incidence of complications, and frequency and efficacy of rescue placement of a supraglottic airway device were also tabulated. Changes in quality of mask ventilation after injection of a neuromuscular blocking agent were assessed. RESULTS: The incidence of difficult mask ventilation was 9% (483 of 5453 patients). Infants and patients having increased weight, being less than 5th percentile in weight for age, or having Treacher-Collins syndrome, glossoptosis, or limited mouth opening were more likely to have difficult mask ventilation. Anaesthetic induction using facemask and opioids was associated with decreased risk of difficult mask ventilation. The incidence of complications was significantly higher in patients with "difficult" mask ventilation than in patients without. Rescue placement of a supraglottic airway improved ventilation in 71% (96 of 135) of cases. Administration of neuromuscular blocking agents was more frequently associated with improvement or no change in quality of ventilation than with worsening. CONCLUSIONS: Certain abnormalities on physical examination should increase suspicion of possible difficult facemask ventilation. Rescue use of a supraglottic airway device in children with difficult or impossible mask ventilation should be strongly considered.